From the Departments of Plastic, Reconstructive and Aesthetic Surgery and Cardiovascular Surgery, Nippon Medical School; and Department of Education, University of Tokyo.
Plast Reconstr Surg. 2022 Sep 1;150(3):659-669. doi: 10.1097/PRS.0000000000009451. Epub 2022 Jul 6.
Surgery is a well-known trigger of keloid and hypertrophic scarring. Sternotomy scars are subject to high skin tension, which is known to promote pathologic scarring. This suggests that sternotomies in adults are associated with high pathologic scarring rates, which aligns with the authors' anecdotal experience. However, this notion has never been examined formally. Therefore, the authors conducted a survey-based cohort study of patients who had undergone a sternotomy.
All consecutive Japanese adults (18 years of age or older) who underwent cardiovascular surgery with sternotomy in 2014 to 2017 were identified in 2019 by chart review and sent a questionnaire. Respondents formed the study cohort. The questionnaire presented randomly ordered photographs of representative mature, keloid, and hypertrophic scars and asked the patients to choose the image that best resembled their midline scar when it was particularly noticeable. The incidence of self-reported pathologic scarring (keloids and hypertrophic scars were grouped together) and the patient demographic (age and sex) and clinical characteristics (intima-media thickness of the left and right common and internal carotid arteries) that were associated with pathologic scarring were determined.
Of the 548 patients who underwent sternotomy, 328 responded for a 60 percent response rate. The mean patient age was 67 years, and 68.0 percent were male. Of these patients, 195 (59.5 percent) reported they had a pathologic scar. Compared with patients who had a mature scar, patients who had a pathologic scar had younger mean age (65 versus 69 years; p = 0.0002) and lower intima-media thickness (0.92 versus 1.05 mm; p = 0.028).
Sternotomy was associated with a high rate of pathologic scarring. Older age and arteriosclerosis were associated with less pathologic scarring.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
手术是导致瘢痕疙瘩和增生性瘢痕的已知诱因。胸骨切开术的疤痕会受到高皮肤张力的影响，这已知会促进病理性瘢痕形成。这表明成年人的胸骨切开术与高病理性瘢痕形成率有关，这与作者的经验相符。然而，这一观点从未被正式检验过。因此，作者对 2014 年至 2017 年间接受胸骨切开术的患者进行了一项基于问卷调查的队列研究。
2019 年，通过病历回顾，共确定了 2014 年至 2017 年间接受心血管手术并进行胸骨切开术的所有连续日本成年人（18 岁或以上），并向他们发送了一份问卷。答卷者组成了研究队列。问卷中呈现了代表性成熟瘢痕、瘢痕疙瘩和增生性瘢痕的随机顺序照片，并询问患者当他们的中线瘢痕特别明显时，选择最能代表他们的瘢痕的照片。确定了与病理性瘢痕相关的自报病理性瘢痕（瘢痕疙瘩和增生性瘢痕归为一组）发生率和患者人口统计学（年龄和性别）及临床特征（左右颈总动脉和颈内动脉的内膜-中层厚度）。
在接受胸骨切开术的 548 名患者中，有 328 名患者做出回应，回应率为 60%。患者的平均年龄为 67 岁，68.0%为男性。在这些患者中，195 名（59.5%）报告他们有病理性瘢痕。与有成熟瘢痕的患者相比，有病理性瘢痕的患者年龄较小（65 岁与 69 岁；p = 0.0002），内膜-中层厚度较低（0.92 毫米与 1.05 毫米；p = 0.028）。
胸骨切开术与病理性瘢痕形成率高有关。年龄较大和动脉粥样硬化与较少的病理性瘢痕形成有关。
临床问题/证据水平：风险，III。
